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Urinary stone disease in adults with celiac disease: prevalence, incidence and urinary determinants.

Abstract

PURPOSE

Intestinal diseases may cause urinary stone disease via hyperoxaluria or diarrhea induced hyperconcentrated acidic urine. Data are missing on urinary stone disease in celiac disease, a common malabsorptive disorder. In this study we analyzed urinary stone disease and urine composition in adults with celiac disease.

MATERIALS AND METHODS

Study patients were 18 years or older, untreated, and newly diagnosed with celiac disease by serum markers and jejunal biopsy. Clinical presentation of celiac disease was assessed focusing on 5 disorders of diarrhea, and deficiency of calorie (low body mass index or weight loss), lipid (low prothrombin time or low serum lipids), iron (low hemoglobin or low serum ferritin) and calcium (low serum calcium or low bone densitometry). Urinary stone disease history was assessed by questionnaire (imaging, stone excretion, stone disruption/removal). Urinary variables were measured in a 24-hour collection in a subgroup of patients.

RESULTS

Under untreated conditions (baseline) urinary stone disease was independent of celiac disease presentation and more prevalent in patients with celiac disease than in a population sample used as a control (608 and 3,540, 7.9% and 5.0%, sex and age adjusted odds ratio 4.0, 95% CI 2.7-5.9). Excluding from analysis individuals with baseline urinary stone disease, the incidence of urinary stone disease history was not significantly different between the treated celiac disease (gluten-free diet) and control population (458 and 3,003, 2.4% vs 3.9%). The urine of untreated patients with celiac disease differed from that of healthy volunteers with 120% higher oxalate and 43% lower calcium (in 45 and 45, p <0.001). A gluten-free diet corrected urinary abnormalities (p <0.01).

CONCLUSIONS

Urinary stone disease risk is high in untreated patients with celiac disease independent of overt malabsorption. Hyperoxaluria is likely the underlying disorder. A gluten-free diet reduces urinary stone disease risk and oxaluria.

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  • Authors+Show Affiliations

    ,

    Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy.

    , , , , ,

    Source

    The Journal of urology 180:3 2008 Sep pg 974-9

    MeSH

    Adolescent
    Adult
    Analysis of Variance
    Biomarkers
    Calcium
    Celiac Disease
    Chi-Square Distribution
    Female
    Humans
    Incidence
    Jejunum
    Logistic Models
    Male
    Middle Aged
    Oxalic Acid
    Prevalence
    Risk Factors
    Surveys and Questionnaires
    Urinary Calculi

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    18639267

    Citation

    Ciacci, Carolina, et al. "Urinary Stone Disease in Adults With Celiac Disease: Prevalence, Incidence and Urinary Determinants." The Journal of Urology, vol. 180, no. 3, 2008, pp. 974-9.
    Ciacci C, Spagnuolo G, Tortora R, et al. Urinary stone disease in adults with celiac disease: prevalence, incidence and urinary determinants. J Urol. 2008;180(3):974-9.
    Ciacci, C., Spagnuolo, G., Tortora, R., Bucci, C., Franzese, D., Zingone, F., & Cirillo, M. (2008). Urinary stone disease in adults with celiac disease: prevalence, incidence and urinary determinants. The Journal of Urology, 180(3), pp. 974-9. doi:10.1016/j.juro.2008.05.007.
    Ciacci C, et al. Urinary Stone Disease in Adults With Celiac Disease: Prevalence, Incidence and Urinary Determinants. J Urol. 2008;180(3):974-9. PubMed PMID: 18639267.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Urinary stone disease in adults with celiac disease: prevalence, incidence and urinary determinants. AU - Ciacci,Carolina, AU - Spagnuolo,Giuliano, AU - Tortora,Raffaella, AU - Bucci,Cristina, AU - Franzese,Domenica, AU - Zingone,Fabiana, AU - Cirillo,Massimo, Y1 - 2008/07/17/ PY - 2007/12/03/received PY - 2008/7/22/pubmed PY - 2008/9/19/medline PY - 2008/7/22/entrez SP - 974 EP - 9 JF - The Journal of urology JO - J. Urol. VL - 180 IS - 3 N2 - PURPOSE: Intestinal diseases may cause urinary stone disease via hyperoxaluria or diarrhea induced hyperconcentrated acidic urine. Data are missing on urinary stone disease in celiac disease, a common malabsorptive disorder. In this study we analyzed urinary stone disease and urine composition in adults with celiac disease. MATERIALS AND METHODS: Study patients were 18 years or older, untreated, and newly diagnosed with celiac disease by serum markers and jejunal biopsy. Clinical presentation of celiac disease was assessed focusing on 5 disorders of diarrhea, and deficiency of calorie (low body mass index or weight loss), lipid (low prothrombin time or low serum lipids), iron (low hemoglobin or low serum ferritin) and calcium (low serum calcium or low bone densitometry). Urinary stone disease history was assessed by questionnaire (imaging, stone excretion, stone disruption/removal). Urinary variables were measured in a 24-hour collection in a subgroup of patients. RESULTS: Under untreated conditions (baseline) urinary stone disease was independent of celiac disease presentation and more prevalent in patients with celiac disease than in a population sample used as a control (608 and 3,540, 7.9% and 5.0%, sex and age adjusted odds ratio 4.0, 95% CI 2.7-5.9). Excluding from analysis individuals with baseline urinary stone disease, the incidence of urinary stone disease history was not significantly different between the treated celiac disease (gluten-free diet) and control population (458 and 3,003, 2.4% vs 3.9%). The urine of untreated patients with celiac disease differed from that of healthy volunteers with 120% higher oxalate and 43% lower calcium (in 45 and 45, p <0.001). A gluten-free diet corrected urinary abnormalities (p <0.01). CONCLUSIONS: Urinary stone disease risk is high in untreated patients with celiac disease independent of overt malabsorption. Hyperoxaluria is likely the underlying disorder. A gluten-free diet reduces urinary stone disease risk and oxaluria. SN - 1527-3792 UR - https://www.unboundmedicine.com/medline/citation/18639267/Urinary_stone_disease_in_adults_with_celiac_disease:_prevalence_incidence_and_urinary_determinants_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5347(08)01227-5 DB - PRIME DP - Unbound Medicine ER -